Document Detail

Technetium-99m pyrophosphate/thallium-201 dual-isotope SPECT imaging predicts reperfusion injury in patients with acute myocardial infarction after reperfusion.
MedLine Citation:
PMID:  18787823     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Microcirculatory failure after reperfusion is clinically indicated to cause reperfusion injury whereas excessive intracellular calcium ion overload is experimentally proved as a key mechanism of reperfusion injury. We hypothesized that technetium-99m ((99m)Tc) pyrophosphate (Tc-PYP) uptake in injured but viable infarct-related myocardium with preserved myocardial perfusion after reperfusion estimated by thallium-201 ((201)Tl) uptake would be associated with final functional recovery. METHODS: Dual-isotope Tc-PYP/(201)Tl single-photon emission computed tomography (SPECT) was performed 2 days after successful reperfusion therapy in patients with first acute myocardial infarction, and 50 patients (63 +/- 13 years old, female 22%) with preserved (201)Tl uptakes of > or = 50% in reperfused myocardium was followed for 1 month. Tc-PYP uptake was assessed as the heart-to-sternum (H/S) ratio. Two-dimensional echocardiography was also performed 2 days and 1 month after reperfusion to evaluate functional recovery. RESULTS: High Tc-PYP uptake, defined as the H/S ratio > or = 0.81, was predictive of chronic phase no functional recovery (73.7% in 14 of 19 patients with high uptake vs 16.1% in five of 31 patients without those, p < 0.0001). After adjustment for potential confounding variables, including electrocardiographic persistent ST segment elevation at 1 h after reperfusion, high Tc-PYP uptake remained independently predictive of no functional recovery with odds ratio of 8.7 (95% confidential interval = 2 to 38.7; p = 0.005). CONCLUSION: High Tc-PYP uptake in reperfused but viable infarct-related myocardium was a powerful predictor of no functional recovery, which may reflect excessive intracellular calcium ion overload caused by reperfusion injury. Tc-PYP/(201)Tl dual-isotope SPECT imaging can provide prognostic information after reperfusion.
Yasushi Akutsu; Kyouichi Kaneko; Yusuke Kodama; Hui-Ling Li; Hideki Nishimura; Yuji Hamazaki; Jumpei Suyama; Akira Shinozuka; Takehiko Gokan; Youichi Kobayashi
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Publication Detail:
Type:  Journal Article     Date:  2008-09-12
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  36     ISSN:  1619-7089     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-27     Completed Date:  2009-03-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  230-6     Citation Subset:  IM    
Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
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MeSH Terms
Myocardial Infarction / physiopathology,  surgery*
Myocardial Reperfusion Injury / metabolism,  physiopathology,  radionuclide imaging*
Recovery of Function
Technetium Tc 99m Pyrophosphate / diagnostic use*,  metabolism
Thallium Radioisotopes / diagnostic use*,  metabolism
Tomography, Emission-Computed, Single-Photon / methods*
Reg. No./Substance:
0/Technetium Tc 99m Pyrophosphate; 0/Thallium Radioisotopes

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